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Obesity Surgery

, Volume 20, Issue 7, pp 876–880 | Cite as

Postoperative Nausea and Vomiting with Application of Postoperative Continuous Positive Airway Pressure after Laparoscopic Gastric Bypass

Research Article

Abstract

Background

This study was performed to assess postoperative nausea and vomiting (PONV) with application of postoperative continuous positive airway pressure (CPAP) for patients undergoing Roux-en-Y gastric bypass (RYGB).

Methods

The anesthesia database was searched for patients who underwent RYGB for 5 years. Three hundred fifty-six patients met the inclusive criteria. Wilcoxon two-sample rank test, Fisher’s exact test, and multivariate logistic regression were used to analyze the data and identify the potential factors. A p value less than 0.05 was considered significant.

Results

The overall incidence of the PONV (nausea or emesis or both) was 42%during the first 24 h postoperatively. Thirty-six percent and 35% in CPAP and no-CPAP groups respectively had reported nausea in postanesthesia care unit (PACU). There was no difference between groups (p > 0.05). There was a less frequent occurrence of emesis in both groups. The incidence of emesis in PACU was 19% in CPAP group and 17% in no-CPAP group (p > 0.05). No statistically significant differences of PONV in postoperative 24 h could be shown between the groups (p > 0.05). The postoperative hypertension occurred more often and intravenous antihypertensive medications were required more in no-CPAP patients (p = 0.013). More patients in no-CPAP group developed oxygenation disturbances (p = 0.012).The mean length of PACU stay was significantly longer in this group (p = 0.029). Reintubation and intensive care unit admission occurred more frequently in no-CPAP patients; however, the difference did not reach statistical significance.

Conclusions

There was no significantly increased risk of PONV with the use of postoperative CPAP. We recommend the routine use of postoperative CPAP for patients with obstructive sleep apnea undergoing RYGB to optimize their respiratory function.

Keywords

Continuous positive airway pressure Postoperative nausea and vomiting Laparoscopic gastric bypass Obstructive sleep apnea 

References

  1. 1.
    Young T, Peppard PE, Taheri S. Excess weight and sleep disordered breathing. J Appl Physiol. 2005;99 4:1592–9.CrossRefPubMedGoogle Scholar
  2. 2.
    Vgontzas AN, Tan TL, Bixler EO, et al. Sleep apnea and sleep disruption in obese patients. Arch Intern Med. 1994;154 15:1705–11.CrossRefPubMedGoogle Scholar
  3. 3.
    Lara MD, Kothari AN, Sugerman HJ. Surgical management of obesity: a review of the evidence relating to the health benefits and risk. Treat Endocrinol. 2005;4 1:55–64.CrossRefPubMedGoogle Scholar
  4. 4.
    Ogerg B, Poulsen TD. Obesity: an anaesthetic challenge. Acta Anaesthesiol Scand. 1996;40 2:191–200.CrossRefGoogle Scholar
  5. 5.
    Rezaiguia S, Jayr C. Prevention of respiratory complications after abdominal surgery. Ann Fr Anesth Reanim. 1996;15:623–46.PubMedGoogle Scholar
  6. 6.
    Kyzer S, Lavie P, Ovnat A, et al. Obstructive sleep apnea in the obese. World J Surg 1998;22:998–1001.CrossRefPubMedGoogle Scholar
  7. 7.
    Pelosi P, Ravagnan I, Giurati G, et al. Positive end-expiratory pressure improves respiratory function in obese but not in normal subjects during anesthesia and paralysis. Anesthesiology 1999;91:1221–31.CrossRefPubMedGoogle Scholar
  8. 8.
    Joris JL, Sottiaux TM, Chiche JD, et al. Effect of bi-level positive airway pressure (biPAP) nasal ventilation on the postoperative pulmonary restrictive syndrome in obese patients undergoing gastroplasty. Chest 1997;111:665–70.CrossRefPubMedGoogle Scholar
  9. 9.
    Huerta S, Deshields S, Shpiner R. Safety and efficacy of postoperative continuous positive airway pressure to prevent pulmonary complications after Roux-en-Y gastric bypass. J Gastrointest Surg 2002;6:354–8.CrossRefPubMedGoogle Scholar
  10. 10.
    Nascimento J, Posner D, Rogers M, et al. Risks of noninvasive positive pressure ventilation postoperatively in laparoscopic gastric bypass patients. Crit Care Med 2006;33 12:a116.Google Scholar
  11. 11.
    Gupta R, Parvizi J, Hanseen A, et al. Postoperative complications in patients with obstructive sleep apnea syndrome undergoing hip or knee replacement: a case-control study. Mayo Clin Proc. 2001;76:897–905.CrossRefPubMedGoogle Scholar
  12. 12.
    Clergue F, Whitelaw WA, Charles JC, et al. Inferences about respiratory muscle use after cardiac surgery from compartment volume and pressure measurements. Anesthesiology 1995;82:1318–27.CrossRefPubMedGoogle Scholar
  13. 13.
    Moos DD, Prasch M, Cantral DE, et al. Are patients with obstructive sleep apnea syndrome appropriate candidates for the ambulatory surgical center? AANA J. 2005;73 3:197–204.PubMedGoogle Scholar
  14. 14.
    Kakkar RK. Positive airway pressure treatment for obstructive sleep apnea. Chest 2007;132:1057–72.CrossRefPubMedGoogle Scholar
  15. 15.
    Gross JB, Bachenberg KL, Benumof JL, et al. Practice guidelines for the perioperative management of patients with obstructive sleep apnea: a report by the American Society of Anesthesiologists Task Force on Perioperative Management of patients with obstructive sleep apnea. Anesthesiology 2006;104:1081–93.CrossRefPubMedGoogle Scholar
  16. 16.
    Becker HF, Jerrentrup A, Ploch T, et al. Effect of nocturnal nasal continuous positive airway pressure treatment on blood pressure in patients with obstructive sleep apnea. Circulation 2003;107:68–73.CrossRefPubMedGoogle Scholar
  17. 17.
    Pepperell JC, Ramdasssing-Dow S, Crosthwaite N, et al. Ambulatory blood pressure after therapeutic and subtherapeutic nasal continuous positive airway pressure for obstructive sleep apnea: a randomized parallel trial. Lancet 2002;359:204–10.CrossRefPubMedGoogle Scholar
  18. 18.
    Bazzano LA, Khan Z, Renyolds K, et al. Effect of nocturnal nasal continuous positive pressure on blood pressure in obstructive sleep apnea. Hypertension 2007;50:417–23.CrossRefPubMedGoogle Scholar
  19. 19.
    Carlsson C, Sonden B, Thylen U. Can postoperative continuous positive airway pressure (CPAP) prevent pulmonary complication after abdominal surgery? Intensive Care Med. 1981;7:225–9.CrossRefPubMedGoogle Scholar
  20. 20.
    Thomas AN, Ryan JP, Pollard BJ. Nasal CPAP after coronary artery surgery. Anaesthesia 1992;47:316–9.CrossRefPubMedGoogle Scholar
  21. 21.
    Böhner H, Kindgen-milles D, Crust A, et al. Prophylactic nasal continuous positive airway pressure after major vascular surgery: results of a prospective randomized trial. Langenbeck’s Arch Surg 2002;387:21–6.CrossRefGoogle Scholar

Copyright information

© Springer Science + Business Media, LLC 2008

Authors and Affiliations

  1. 1.Department of AnesthesiologyUniversity of PittsburghPittsburghUSA

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